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VOLUME 27 , ISSUE 5 ( May, 2023 ) > List of Articles

PEDIATRIC CRITICAL CARE MEDICINE

Flexible Fiberoptic Bronchoscopy in Non-ventilated Children in Pediatric Intensive Care Unit: Utility, Interventions and Safety

Anil Sachdev, Anuj Khatri, Ganpat Jha, Dhiren Gupta, Suresh Gupta

Keywords : Airway assessment, Bronchoalveolar lavage, Diagnostic Procedure, Flexible bronchoscopy, Pediatric intensive care unit

Citation Information : Sachdev A, Khatri A, Jha G, Gupta D, Gupta S. Flexible Fiberoptic Bronchoscopy in Non-ventilated Children in Pediatric Intensive Care Unit: Utility, Interventions and Safety. Indian J Crit Care Med 2023; 27 (5):358-365.

DOI: 10.5005/jp-journals-10071-24449

License: CC BY-NC 4.0

Published Online: 29-04-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Objective: To study the utility of flexible fiberoptic bronchoscopy (FFB), and its effects on oxygenation and hemodynamics in children while on respiratory assist devices. Materials and methods: The data of non-ventilated patients who underwent FFB during their stay in the PICU from January 2012 to December 2019 was retrieved from medical, nurses, and bronchoscopy records. The study parameters, demography, diagnosis, indication, and findings of FFB and interventions done after FFB, were noted, and also the oxygenation and hemodynamic parameters before, during and 3 hours after FFB. Results: Data from the first FFB of 155 patients were analyzed retrospectively. About 54/155 (34.8%) children underwent FFB while on HFNC. About 75 (48.4%) patients were on conventional oxygen therapy (COT) before FFB. There were 51 (33%) patients who had received mechanical ventilation and were extubated successfully. The 98 (63.2%) children had primary respiratory diseases. Stridor and lung atelectasis were indications for FFB in 75 (48.4%) cases and the commonest bronchoscopic finding was retained secretions in the airways. Based on the FFB findings, 50 medical and 22 surgical interventions were done. The commonest medical and surgical interventions were changes in antibiotics (25/50) and tracheostomy (16/22) respectively. There was a significant fall in SpO2 and a rise in hemodynamic parameters during FFB. All these changes were reversed after the procedure with no consequences. Conclusion: Flexible fiberoptic bronchoscopy is a useful tool to diagnose and guide interventions in non-ventilated pediatric intensive care unit (PICU). There were significant but transient changes in oxygenation and hemodynamics with no serious consequences.

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